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Why opt for private care?

Having the private obstetric care package allows you to see and get to know your obstetrician from the earliest stage of pregnancy. You’ll get the chance to meet with the same and most qualified person at each and every one of your appointments, which prevents receiving confusing or even conflicting information. In the very rare event of your obstetrician not being available, she will arrange cover by a close consultant colleague from her immediate team

During your pregnancy, private care allows you to have direct access to a consultant specialist in the maternity unit, who will answer your questions personally and help allay anxieties, queries and fears. They will also be available for any emergencies. As a private patient you will also have more flexibility regarding appointment times and a more efficient handling of any your queries and concerns.

Over the course of your ante-natal appointments you will develop a personal and close relationship with your consultant obstetrician and this helps significantly when you’re in labour. Knowing that you have one of the most highly trained and experienced clinicians at hand can make labour a lot less stressful.

And, there are the obvious comforts of the private unit. Having your own room and bathroom is really important when you have just given birth and want to enjoy those special moments with your new baby and family.

Dieting in pregnancy

In pregnancy, as at any other time, it is important to maintain a health balanced diet. Whilst you may be hungrier, it’s a myth that you need to eat for two. Adjusting your snacks and choosing healthier options can be one way of tackling your hunger without eating excess sweet, fat or processed food.

Visiting the dentist

Dental problems can occur in pregnancy and bleeding gums are common. It is safe and advisable to have routine appointments in pregnancy. Always inform your dentist if you are pregnant as it may not be obvious in the early stages. They can then modify the treatments if required. For example, dental xrays are usually avoided in pregnancy but there can be occasions when the risks of the xray are outweighed by the benefits if urgent treatment is required.

If you are entitled to NHS care, you will also be entitled for free NHS dental care. You will need to show the dentists either a MATB1 or a prescription exemption certificate as proof.

Is air travel safe in pregnancy?

Air travel is safe in pregnancy if you have an uncomplicated/ low risk pregnancy. If you want to fly after 28 weeks you will need a letter from your doctor but the airline still have the power to refuse to carry you.

In general terms, long haul flights are safe until about 30 weeks of pregnancy and short haul flights until 36 weeks if you have a single fetus. The guidance for twins is less flexible. The specific rules vary for each airline and it is important to check with them. Not only must you consider how many weeks you will be when you fly, but also how many you’ll be when you return.

If you have any medical problems or are high risk, you should discuss your travel plans with your doctor.

What can be more concern is where you’re flying to? This is something you will need to think carefully about and the risks you are willing to accept. For example, will there be adequate medical facilities nearby and could they look after a pre-term baby? And, if you did deliver early, would you be willing to stay there until the baby was fit to travel. You will also need to ensure that your travel insurance covers pregnancy as many policies exclude this.

Should I have the whopping cough (pertussis) vaccine?

All pregnant women have been offered the whopping cough vaccine between 28 and 38 weeks of pregnancy since 2012. This is even if they have been vaccinated as a child as the effects of previous vaccines may have worn off. The vaccine is being offered because there has been a dramatic increase in the number of reported cases of whopping cough in the UK. Babies are not vaccinated against whopping cough until they are two months old. This leaves them vulnerable in their first few weeks of life. By having the vaccine, antibodies cross the placenta which will protect your new born baby.

It is a potentially serious condition and babies who contract the condition are at risk of pneumonia and brain damage.

The vaccine has been widely used and there is no evidence of it being harmful. It is not a live vaccine, so women cannot catch whopping cough.

Should I have the influenza vaccine?

Understandably, women are concerned about having any vaccinations in pregnancy. It is strongly recommended by national UK organisations that pregnant women have the influenza vaccination. The influenza vaccine is a safe and thoroughly tested vaccine, which is not live and cannot lead to the baby or mother getting influenza.

It’s safe for the mother and not only reduces the chances of catching influenza but also the serious complications associated with it (such as, pneumonia).

Having the vaccine will also protect your baby by decreasing the chances of miscarriage, early birth and low birthweight. It will also give the baby protection against influenza in the first few months of life.

What foods must I avoid?

The list of forbidden foods seems to grow as you ask more people for advice. Here is a general list:Dairy: Unpasteurised milk and cheese, blue veined cheese, mould ripened soft cheeses (e.g. brie, chevre, camembert), raw/uncooked eggs.Meat: any under-cooked/raw meat, pate, liver.Fish: some types of fish (marlin, shark, swordfish and limit tuna), raw shellfish, sushi if the fish used has not been frozenCaffeine: It is advisable to limit caffeine in pregnancy. As a general rule, only one cup of coffee or tea per day
Avoid all supplements containing vitamin A

Can I exercise in pregnancy?

For women who exercise regularly, it is fine to continue. It will help you maintain fitness in pregnancy and return to your full fitness after you have had the baby. In addition, exercising will help you adjust to your new body shape and posture. There is good research evidence, which shows that women who do exercise in pregnancy tend to have more easy deliveries. There is no evidence that exercise is associated with miscarriage.

It’s important to remember that you should not overheat when exercising. To avoid overheating, wear loose clothing, exercise in a well-ventilated area and drink water. Also, do not over strain yourself. You should not get very out of breath.

If you are not used to exercising, it is not advisable to take up new strenuous forms of exercise. Try gentle exercises that you can follow at your own pace, such as, walking, swimming or using an exercise bicycle. If doing exercise classes or following a programme with a personal trainer, it is essential you inform your instructor that you are pregnant.

How much weight should I gain?

There are no set targets and we do not recommend regularly weighing yourself. Many years ago it was standard practice for your obstetrician to weigh you. Nowadays this is not measured as there is little benefit and only creates unnecessary anxiety for mothers to be.

Women gain on average between 11 and 18 kgs in pregnancy. Women with a lower body mass index tend to put on more weight, whilst heavier women may gain less. It isn’t something you should be worrying about and it is of course possible to lose the weight afterwards.

How much should I be eating?

The simple answer is not for two, but healthily for one. Surprisingly, women need few extra calories for most of the pregnancy. This is good news given how sick some women get in early pregnancy.

For the first two trimesters, you do not need any more calories and in the third trimester, you need an extra 200 calories per day. 200 extra calories is actually very little, for example, a glass of fresh juice or small cup of nuts, half a pita bread with hummus, half an apple and a teaspoon of peanut butter.

Do all women have an episiotomy?

An episiotomy is when an obstetrician or midwife makes a cut in a women’s perineum (the area between the vagina and anus) during labour. It makes the vaginal opening a bit wider to help the baby come through more easily.

In England, episiotomies aren’t carried out routinely. The National Institute for Health and Clinical Excellence (NICE) recommends that an episiotomy should be considered if the baby is distress and needs to be born quickly, or if there is clinical need such as an assisted delivery where forceps or ventouse are required.

The national data indicates that approximately 1 in 7 deliveries involve an episiotomy.

How much caffeine can I have in pregnancy?

You should try to limit your caffeine intake to no more than 200mg/day. This is because high levels of caffeine during pregnancy can result in babies having a low birth weight, which can increase the risk of health problems in later life.

You could try decaffeinated tea or coffee, or fruit juices or water instead.

Caffeine is found in coffee, tea, chocolate and also some soft drinks, energy drinks and cold and flu remedies.

A quick guide is as follows:

One mug of instant coffee: 100mg
One mug of filter coffee: 140mg
One mug of tea: 75mg
One can of cola: 40mg
One can of energy drink: up to 80mg
One 50g bar of plain chocolate: up to 50mg
One 50g bar of milk chocolate: up to 25mg.

I have been advised to have colposcopy in pregnancy. Is it safe?

This is a simple examination, which allows your doctor to see how the cells on your cervix have changed by using a lighted magnifying instrument. It is perfectly safe to have this examination during pregnancy.

Should I go for my routine smear test during pregnancy?

It is probably best to wait until after delivery to have a routine smear test. The reason for this is that pregnancy makes the result of your test harder to interpret. However, if you have previously had an abnormal result or are not up to date (no test in the last 3-5 years) you may need to be screened.

What are pelvic floor exercises and do I need to do them?

Your pelvic floor is largely made up of muscles and ligaments and it stretches from your pubic bone to the base of your spine. It provides support for your bladder, bowel and womb. It is like a trampoline and is able to stretch and bounce back, however, if it is stretched for a long time, as in pregnancy, those muscles can become slack. This can lead to stress incontinence (leaking urine when you cough/sneeze/exercise) and can also affect your vaginal muscles which could lead to less satisfying sex. The good news is that you can do exercises to strengthen these muscles; in fact you should aim to do them daily for the rest of your life!

If you haven’t been shown how to do these exercises at antenatal class, then ask your obstetrician or midwife. However, a quick start guide is to imagine that you are trying to stop a flow of urine mid stream and trying to stop yourself from passing wind at the same time. You should get a feeling of lifting and tightening. Try and hold this for 10 seconds and breathe freely at the same time. Repeat 8 times, 3 times a day!

When can I find out the sex of my baby?

During your anomaly scan, sometime after 18 weeks, the ultra sonographer may be able to tell the sex of your baby. This is not 100% accurate as it depends on how the baby is lying in your womb i.e. whether it is possible to get a clear view of the genital area. However, if you have an amniocentesis (or Chorionic Villus Sampling test, which are done for other reasons, then the sex of your baby can be predicted with almost 100% accuracy.

What is the anomaly scan for?

This is an ultrasound scan that is performed between 18-21 weeks of pregnancy. The purpose is to check if the baby is developing well and as expected, and if not then to identify what the problem is and what options are available. There are however limitations to what anomalies can be detected.

If you would like to know the sex of your baby then this is the earliest time to find out.

Is pethidine safe for my baby?

Pethidine is an opioid and can provide pain relief during labour. It starts working about half an hour after being given and can last for a few hours. It is given via an injection into your arm or leg. The pain relief is often limited although some women find it makes them feel more relaxed and enables them to sleep in early labour. It can make your baby feel more sleepy but this effect is very short lived and not a concern in early labour.

What is a TENS machine?

TENS stand for Transcutaneous electrical nerve stimulation. It can be helpful at the beginning of labour, particularly for backache. It is a gentle electrical current that is passed through flat pads stuck to your back. This creates a tingling feeling and you can control the strength of the current yourself. It has no known harmful effects on your baby. If you would like to use a TENS machine, you will need to hire or buy one prior to labour.

Is a forceps or ventouse delivery safe for my baby?

A ventouse is an instrument that uses suction to attach a cup to your baby’s head. Your obstetrician will wait for you to have a contraction while gently pulling the ventouse to help you deliver your baby. The suction cup can cause a mark on the baby’s head, which usually disappears within 48 hrs. It may also cause a bruise on the baby’s head which rarely causes any problems and again disappears with time.

Forceps are metal instruments that look like large spoons and are curved to fit around a baby’s head. If required your obstetrician will gently pull the forceps when you are having a contraction. Forceps marks on the baby’s face, although very common are usually small and normally disappear within 48 hrs.

Forceps and ventouse will only be used to deliver your baby if they are the safest method of delivery for you both. Your obstetrician will choose the type of instrument that is most suitable for you, your baby and your situation.

Should I consider stem cell collection?

This is the collection of stem cells from the baby’s blood that remains in the placenta and umbilical cord after birth (cord blood). Cord blood can be used to treat blood related disorders such as leukaemia, some immune system disorders and some metabolic storage disorders. It may be that in the future more diseases will be treated with cord blood but at present much more research is needed.

You can store cord blood in the hope that the stem cells may be useful should a member of the family develop a disease treatable by stem cell therapy. However the chances of your child ever needing to use this blood are extremely small.

If you are interested in doing this, you will need to arrange for collection and storage of cord blood through a private company who will charge you for this service.

My baby is breech, now what?

This means the baby is lying with it’s bottom down rather than the more usual position of head down. It only matters from the 36th week of pregnancy as before this the baby will most likely turn around on it’s own.

You will need an ultrasound to confirm your baby’s position and to see if there is a particular reason for your baby to be in the breech position, e.g. fibroids or a low placenta.

There are 3 choices :

External Cephalic version( ECV)

ECV involves your Obstetrician trying to turn your baby around after 37 weeks of pregnancy. It has about a 60% chance of success.

Caesarean section

Vaginal breech delivery

Your obstetrician will talk to you about these options so that you can make the best choice for you and your baby, as every case is individual.

Why are babies given Vitamin K?

There is a rare but life-threatening disease called Vitamin K Deficiency Bleeding (VKDB) also known as Haemorrhagic Disease of the Newborn (HDN) that occurs in approximately 1:10,000 babies. An injection of Vitamin K into your baby’s leg soon after birth will prevent your baby from getting HDN. This injection has been used in Britain for over 30 years and extensive reviews of its use have confirmed its safety.

Will I have enough milk for my baby?

This is a very normal worry, but be reassured that the more your baby feeds the more milk you will make. This is because when your baby feeds you release a hormone called Prolactin, which stimulates your body to make more milk. So each time you baby feeds he/she is ordering the next meal!

Can I breast feed if I’ve had implants?

Probably yes, though you won’t know exactly if your milk supply has been affected until to try to breast feed. It will depend on the kind of surgery that you had but if you still have feeling in your nipple you have a much better chance of having a full milk supply.

What are the benefits of breast feeding?

Breast milk is the best food for your baby, but the benefits extend well beyond basic nutrition. It contains all the vitamins and nutrients that your baby will need in its first 6 months of life and it will also supply disease-fighting substances to protect your baby from illness. Your body will respond to viruses and bacteria (pathogens) that are in your body and make immune substances that are specific to those pathogens so that you are creating protection for your baby based on whatever you are exposed to. Because of this breastfed babies are much less likely to be ill in their first year of life.

It is good for you too as it helps to lower your risk of breast cancer, osteoporosis and ovarian cancer. It also burns 500-800 calories a day and speeds up the process which shrinks your womb to its pre pregnancy size.

Breast feeding can also help to build a strong bond between you and your baby.

When can I drive after having my baby?

It is normal to wait until your 6 week postnatal check with your doctor as per the DVLA rules. It is also worth noting that some insurance policies do not allow driving for six weeks following a caesarean section and some have restrictions for vaginal births too. This is even if you feel able to drive. Check with your insurer to be certain.

Where do I get a MAT B1 form?

Your doctor or midwife will issue this free of charge.

What is a MAT B1 form?

This is the maternity certificate that’s sole purpose is to enable a pregnant woman to claim Statutory Maternity Pay (SMP) from her employer or Maternity Allowance (MA) from Jobcentre Plus. It confirms that you are pregnant and the date of the expected week of confinement (EWC).

What should I bring for baby?

Babygrows (these are the best for warmth and comfort)

Vests and cardigan/jumper

Socks

Hat

Nappies

Scratch mittens

Baby blanket or something warm for going home

Car seat/buggy to go home in

What should I bring to the hospital?

Do remember to bring in any medication that you are taking, but leave painkillers at home as they will be prescribed for you. Here’s a list of suggestions:

Can I whiten my teeth during pregnancy?

There is little evidence one way or another about teeth whitening during pregnancy. These products often contain a form of peroxide which causes a process called oxidation which can cause damage to tissue and living cells (your tooth enamel does not contain any living cells).

However, due to the lack of research on this matter, it is probably best to wait until after you have had your baby and finished breastfeeding.

Can I wear an underwire bra?

Yes, there are no health issues about having wire in your bra. However, many women opt to have wire-free bras as their pregnancies progress just because they may feel more comfortable.

Can I use a Jacuzzi or hot tub?

Yes, but just be careful not to over heat which would put you at an increased risk of fainting. Also, you should not soak in water hotter than 100 degrees F or 38 degrees C as this could be dangerous for your baby. If you have to ease your foot into the tub, then it’s too hot, if you’re comfortable getting into the water then the temperature is close to your own body temperature, which is fine.

Do I need to remove my belly button piercing?

Yes, with the stretching of your skin and the new shape of your tummy, piercings in the belly button can become very uncomfortable.

Also you will need to remove the ring before a planned caesarean delivery. Also, because unplanned caesarean deliveries occur, you should remove the piercing preferably before or at beginning of labour.

Can I use nail varnish during pregnancy?

Yes, there is little evidence to suggest that a pregnant woman’s exposure to chemicals involved in a manicure or pedicure is harmful to the baby. However extended exposure to the solvents used in manicure salons, (acetone in polish remover and toluene/formaldehyde in nail varnish) is not advisable. If you paint your nails often, you could try using an acetone free polish remover and nail varnish that is free from toluene and formaldehyde.

If you are booked to have a planned caesarean section, then you will need to have all your nail polish removed before your hospital admission.

Can I use hair removal creams during pregnancy?

Yes, although your skin may be more sensitive during pregnancy so you may find that they irritate you more than usual. Try doing a patch test on a small area of skin before using the product, even if you have used it before you were pregnant.

Should I wax before labour?

Please be reassured that your doctors and midwives will be completely focused on the birth of your baby and not on your beauty regime!

Can I have a bikini wax in pregnancy?

Yes, but because there is an increased blood flow to the skin during pregnancy it may be more painful than normal.

Can I use fake tan in pregnancy?

Yes, there are no harmful ingredients so it can be used without concern.

Can I dye / bleach or highlight my hair?

Yes, there is no clear evidence that using hair dye will cause any problems for your baby. Having said that, it is best to avoid in the first trimester of pregnancy. Thereafter, there are some precautions you might want to take:

If using a home-kit, dye your hair in a well ventilated area to reduce inhalation of chemicals and wear gloves

Talk to your hairdresser about using an ammonia free dye

Consider ‘vegetable dyes’

Get streaks or highlights to limit the amount of dye used and during which the chemicals have little or no contact with your skin

http://www.gbss.org.uk/
This is the website for the Group B Strep support group. It provides useful information and support.

https://www.oaa-anaes.ac.uk/content.asp?ContentID=1
This website is for obstetric anaesthetists, but includes a useful section for mothers. It provides information, in many languages, on pain relief options for labour and anaesthesia for caesarean section. The risks of epidural analgesia are also explained.

https://www.tamba.org.uk/
For parents expecting twins or more, these websites have useful information regarding pregnancy and caring more than one baby

About Dr Roshni Patel

Roshni Patel is an accredited specialist in high risk maternal and fetal medicine. She has extensive experience of normal and high risk pregnancy and is a recognised expert at pre-pregnancy counselling & managing medical problems in pregnancy.